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Seki H, Kuratani N, Shiga T, Iwasaki Y, Karita K, Yasuda K, Yamamoto N, Nakanishi Y, Shigematsu K, Kobayashi K, Saito J, Kondo I, Yaida N, Watanabe H, Higashi M, Shirasaka T, Doshu-Kajiura A, Edanaga M, Tanaka S, Ikumi S, Ito S, Okada M, Yorozu T. Incidence of sodium-glucose cotransporter-2 inhibitor-associated perioperative ketoacidosis in surgical patients: a prospective cohort study. J Anesth 2024:10.1007/s00540-024-03335-3. [PMID: 38494577 DOI: 10.1007/s00540-024-03335-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/04/2024] [Indexed: 03/19/2024]
Abstract
PURPOSE Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are commonly prescribed anti-diabetic medications with various beneficial effects; however, they have also been associated with ketoacidosis. The aim of this study was to determine the incidence of SGLT2i-associated perioperative ketoacidosis (SAPKA) in surgical patients. METHODS We conducted a multicenter, prospective cohort study across 16 centers in Japan, enrolling surgical patients with diabetes who were prescribed SGLT2is between January 2021 and August 2022. Patients were monitored until the third postoperative day to screen for SAPKA, defined as urine ketone positivity with a blood pH of < 7.30 and HCO3 level ≤ 18.0 mEq/L, excluding cases of respiratory acidosis. RESULTS In total, 759 of the 762 evaluated patients were included in the final analysis. Among these, three patients (0.40%) had urine ketones with a blood pH of < 7.30; however, blood gas analysis revealed respiratory acidosis in all three, and none of them was considered to have SAPKA. The estimated incidence of SGLT2i-associated postoperative ketoacidosis was 0% (95% confidence interval, 0%-0.4%). CONCLUSIONS The observed incidence of SAPKA in our general surgical population was lower than expected. However, given that the study was observational in nature, interpretation of study results warrants careful considerations for biases.
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Affiliation(s)
- Hiroyuki Seki
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo, Japan.
| | - Norifumi Kuratani
- Department of Anesthesia, Saitama Children's Medical Center, Saitama, Japan
| | - Toshiya Shiga
- Department of Anesthesiology, School of Medicine, International University of Health and Welfare, Chiba, Japan
| | - Yudai Iwasaki
- Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Kanae Karita
- Department of Hygiene and Public Health, Kyorin University School of Medicine, Tokyo, Japan
| | - Kazuki Yasuda
- Department of Diabetes, Endocrinology and Metabolism, Kyorin University School of Medicine, Tokyo, Japan
| | - Natsuko Yamamoto
- Department of Anaesthesia and Intensive Care Medicine, Graduate School of Medicine and Faculty of Medicine, Akita University, Akita, Japan
| | - Yuko Nakanishi
- Department of Anesthesiology and Reanimatology, University of Fukui Hospital, Fukui, Japan
| | - Kenji Shigematsu
- Department of Anesthesiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Kensuke Kobayashi
- Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Junichi Saito
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Ichiro Kondo
- Department of Anesthesiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Nozomu Yaida
- Department of Anesthesiology and Intensive Care Medicine, Kawasaki Medical School, Okayama, Japan
| | - Hidenobu Watanabe
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Midoriko Higashi
- Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tetsuro Shirasaka
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Akira Doshu-Kajiura
- Department of Anesthesiology, Nihon University School of Medicine, Tokyo, Japan
| | - Mitsutaka Edanaga
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - Satoshi Tanaka
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Nagano, Japan
| | - Saori Ikumi
- Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Shingo Ito
- Department of Anesthesiology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Masayuki Okada
- Department of Anesthesiology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Tomoko Yorozu
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo, Japan
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Yamamoto M, Takagi S, Kijima M, Sato H, Doshu-Kajiura A, Kitajima O, Suzuki T. Influence of the Pringle maneuver during partial hepatectomy on the neuromuscular block induced by intermittent and continuous dosing of rocuronium. J Anesth 2023; 37:828-834. [PMID: 37548656 DOI: 10.1007/s00540-023-03239-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/27/2023] [Indexed: 08/08/2023]
Abstract
PURPOSE The Pringle maneuver (PM) is a common procedure in hepatectomy that is known to interrupt drug elimination. The purpose of this study was to examine the influence of PM on the duration of action of rocuronium administered by intermittent bolus dosing, the continuous rocuronium infusion dose required for maintenance of a moderate neuromuscular block, and changes in plasma concentrations of rocuronium. METHODS Twenty-seven adult patients undergoing partial hepatectomy with PM were enrolled in this study. The duration of action of 0.2 mg/kg rocuronium boluses (DUR), and the continuous rocuronium infusion dose required for maintenance of the height of the first twitch of the train-of-four (T1) at 10-20% of the control value (%T1), respectively, were electromyographically monitored on the adductor digiti minimi muscle. The effects of PM on DUR, %T1, and the plasma concentration of rocuronium were measured. RESULTS The DUR was significantly prolonged during PM [mean: 42.2 (SD: 8.0) min, P < 0.001] compared to baseline [29.7 (6.3) min]. It was prolonged even after completion of the PM [46.2 (10.5) min, P < 0.001]. The plasma concentration of rocuronium measured at every reappearance of T1 was comparable between before and during PM. %T1 [15.5 (5.6)%] was significantly depressed after the start of PM [6.5 (3.9)%, P < 0.001], with persistence of the depression even after completion of PM. However, there were no significant changes in the plasma concentration of rocuronium. CONCLUSIONS Rocuronium-induced neuromuscular block is significantly augmented during PM. However, the augmentation is not associated with an increase in plasma rocuronium concentration.
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Affiliation(s)
- Mai Yamamoto
- Department of Anesthesiology, Nihon University School of Medicine, 30-1, Oyaguchi-Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Shunichi Takagi
- Department of Anesthesiology, Nihon University School of Medicine, 30-1, Oyaguchi-Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Miho Kijima
- Department of Anesthesiology, Nihon University School of Medicine, 30-1, Oyaguchi-Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Hanae Sato
- Department of Anesthesiology, Nihon University School of Medicine, 30-1, Oyaguchi-Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Akira Doshu-Kajiura
- Department of Anesthesiology, Nihon University School of Medicine, 30-1, Oyaguchi-Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Osamu Kitajima
- Department of Anesthesiology, Nihon University School of Medicine, 30-1, Oyaguchi-Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Takahiro Suzuki
- Department of Anesthesiology, Nihon University School of Medicine, 30-1, Oyaguchi-Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
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Sato H, Iwasaki H, Doshu-Kajiura A, Katagiri S, Takagi S, Luthe SK, suzuki T. Comparison of two electromyography-based neuromuscular monitors, AF-201 P and TetraGraph, in rocuronium-induced neuromuscular block: a prospective comparative study. Anaesth Crit Care Pain Med 2022; 41:101145. [DOI: 10.1016/j.accpm.2022.101145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/13/2022] [Accepted: 07/25/2022] [Indexed: 12/01/2022]
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Doshu-Kajiura A, Suzuki J, Suzuki T. Prolonged onset and duration of action of rocuronium after accidental subcutaneous injection in a patient with chronic renal failure-a case report. JA Clin Rep 2021; 7:18. [PMID: 33638714 PMCID: PMC7914319 DOI: 10.1186/s40981-021-00421-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/13/2021] [Accepted: 02/15/2021] [Indexed: 11/21/2022] Open
Abstract
Background Drugs administered subcutaneously have delayed onset and prolonged duration of action versus those given intravenously. Since the duration of action of rocuronium is prolonged in patients with renal dysfunction, subcutaneous administration of rocuronium to such patients might significantly prolong its effect. Case presentation A 51-year-old female with chronic renal failure was accidentally administered 1.04 mg/kg rocuronium subcutaneously. Marked prolongation of onset and duration of action of rocuronium were detected on acceleromyography. Slow development of the neuromuscular block was still observed at 100 min after injection. Administration of 4.5 mg/kg sugammadex at 140 min after rocuronium injection facilitated recovery from a train-of-four (TOF) count of 2 to a TOF ratio of 100% within 5 min. No symptoms of postoperative recurarization and upper airway obstruction were observed. Conclusion Neuromuscular monitoring is necessary to evaluate the progress and depth of neuromuscular block, particularly when rocuronium is inadvertently administered subcutaneously.
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Affiliation(s)
- Akira Doshu-Kajiura
- Department of Anesthesiology, Nihon University, School of Medicine, 30-1, Oyaguchi, Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Junko Suzuki
- Department of Anesthesiology, Nihon University, School of Medicine, 30-1, Oyaguchi, Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Takahiro Suzuki
- Department of Anesthesiology, Nihon University, School of Medicine, 30-1, Oyaguchi, Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
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